=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083905772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A2Z DME SPECIALISTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2011
-----------------------------------------------------
Last Update Date | 04/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5333 COMMERCE SQUARE DR SUITE K
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46237-8627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-893-2159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5333 COMMERCE SQUARE DR SUITE K
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46237-8627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-893-2159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JERRY EARL SURBAUGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-725-8229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------